Bottom Line:
We have maintained oral anticoagulation therapy.This case highlights that an early effective anticoagulation heparin therapy is needed for a clear benefit in case of suspected PSMVT.It is certain that the sooner the treatment is given, the better outcome will be.

Affiliation: Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde University Teaching Hospital, Yaoundé, Cameroon.

ABSTRACTCases of splanchnic venous thrombosis have not been described in Cameroon. Their prevalence in acute pancreatitis is variable. With the emergence of acute intra-abdominal infections including typhoid fever and peritoneal tuberculosis in situations of acquired immunodeficiency syndrome, these cases will become frequent. We report the case of a portosplenomesenteric venous thrombosis related to necrotizing acute pancreatitis associated with proteins C and S deficiency, in a 46-year-old Cameroonian man, without particular past medical history. He was admitted for abdominal pain which had been evolving for 3 weeks and accompanied by vomiting. In the absence of hemorrhagic risk factor, the patient received low molecular weight heparin followed by oral warfarin. The abdominal ultrasound check on the 12th day showed a partial recanalization of venous thrombosis. The abdominal contrast-enhanced CT scanner at day 30 on oral anticoagulation therapy showed collateral vessels and small bowel edema. At the same time the upper gastrointestinal endoscopy showed grade II esophageal varices. We have maintained oral anticoagulation therapy. This case highlights that an early effective anticoagulation heparin therapy is needed for a clear benefit in case of suspected PSMVT. It is certain that the sooner the treatment is given, the better outcome will be.

Mentions:
A 46-year-old Cameroonian man, living in North Cameroon, was admitted to the Yaoundé University Teaching Hospital for diffuse abdominal pain accompanied by abdominal distension and vomiting for three-week duration. This was treated as a gastroduodenal ulcer without accurate diagnosis on endoscopy. His past medical history was unremarkable. The physical exam revealed a distended and tympanic abdomen, diffusely tender with no guarding. There was no palpable mass and bowel sounds were present. The digital rectal exam elicited pains on both sides. On admission, he has a low grade fever with a temperature of 38.2°C; the blood pressure was 113/82 mm Hg, and the heart rate 102 beats/minute. The laboratory tests (hemogram and biochemistry) were normal except for a C-reactive protein of 160 mg/L (standards: less than 6 mg/L), the lipase of 6xULN (upper limit of normal), and mild hepatic cytolysis (ALT greater than 3xULN). The tests of the hepatitis B surface antigen, the anti-hepatitis C virus antibodies, and the human immunodeficiency virus (HIV) were negative. Abdominal Doppler ultrasonography revealed an extensive venous thrombosis of the portal, splenic, and mesenteric veins (Figure 1). The abdominal contrast-enhanced CT scanner confirmed the extended thrombosis and highlighted an infiltration of the proximal pancreas associated with inflammatory flows in the peritoneum (Figure 2).

Mentions:
A 46-year-old Cameroonian man, living in North Cameroon, was admitted to the Yaoundé University Teaching Hospital for diffuse abdominal pain accompanied by abdominal distension and vomiting for three-week duration. This was treated as a gastroduodenal ulcer without accurate diagnosis on endoscopy. His past medical history was unremarkable. The physical exam revealed a distended and tympanic abdomen, diffusely tender with no guarding. There was no palpable mass and bowel sounds were present. The digital rectal exam elicited pains on both sides. On admission, he has a low grade fever with a temperature of 38.2°C; the blood pressure was 113/82 mm Hg, and the heart rate 102 beats/minute. The laboratory tests (hemogram and biochemistry) were normal except for a C-reactive protein of 160 mg/L (standards: less than 6 mg/L), the lipase of 6xULN (upper limit of normal), and mild hepatic cytolysis (ALT greater than 3xULN). The tests of the hepatitis B surface antigen, the anti-hepatitis C virus antibodies, and the human immunodeficiency virus (HIV) were negative. Abdominal Doppler ultrasonography revealed an extensive venous thrombosis of the portal, splenic, and mesenteric veins (Figure 1). The abdominal contrast-enhanced CT scanner confirmed the extended thrombosis and highlighted an infiltration of the proximal pancreas associated with inflammatory flows in the peritoneum (Figure 2).

Bottom Line:
We have maintained oral anticoagulation therapy.This case highlights that an early effective anticoagulation heparin therapy is needed for a clear benefit in case of suspected PSMVT.It is certain that the sooner the treatment is given, the better outcome will be.

Affiliation:
Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde University Teaching Hospital, Yaoundé, Cameroon.

ABSTRACTCases of splanchnic venous thrombosis have not been described in Cameroon. Their prevalence in acute pancreatitis is variable. With the emergence of acute intra-abdominal infections including typhoid fever and peritoneal tuberculosis in situations of acquired immunodeficiency syndrome, these cases will become frequent. We report the case of a portosplenomesenteric venous thrombosis related to necrotizing acute pancreatitis associated with proteins C and S deficiency, in a 46-year-old Cameroonian man, without particular past medical history. He was admitted for abdominal pain which had been evolving for 3 weeks and accompanied by vomiting. In the absence of hemorrhagic risk factor, the patient received low molecular weight heparin followed by oral warfarin. The abdominal ultrasound check on the 12th day showed a partial recanalization of venous thrombosis. The abdominal contrast-enhanced CT scanner at day 30 on oral anticoagulation therapy showed collateral vessels and small bowel edema. At the same time the upper gastrointestinal endoscopy showed grade II esophageal varices. We have maintained oral anticoagulation therapy. This case highlights that an early effective anticoagulation heparin therapy is needed for a clear benefit in case of suspected PSMVT. It is certain that the sooner the treatment is given, the better outcome will be.